Provider Demographics
NPI:1437863982
Name:BERHE, GEWEDY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GEWEDY
Middle Name:
Last Name:BERHE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7251 S SOUTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2705
Mailing Address - Country:US
Mailing Address - Phone:312-731-3604
Mailing Address - Fax:
Practice Address - Street 1:1533 E 67TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-4426
Practice Address - Country:US
Practice Address - Phone:773-493-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist